Nursing homes get a makeover
Editor’s note: Two weeks ago, the Pine Journal ran a story on some fairly dramatic changes at Cloquet’s Sunnyside Health Care Center. This week we look at Carlton’s Inter-Faith Care Center. Both nursing homes are reflecting national trends in offering a wider variety of options for elder care facilities.
Picture a nursing home of 20 or even 15 years ago, places where the elderly and the infirm might go to live for years, sometimes even decades.
It’s a different world now. Today people have many more types of facilities to choose from, as well as more services to help them stay at home longer. Nursing homes are adapting to that new reality.
“Today’s nursing homes are almost like step-down hospitals,” Inter-Faith Care Center Director Connie Anderson explained. “The patients we had even 10 years ago are living in assisted care facilities, foster care or staying at home with services. The patients we are getting [for nursing home care] are more clinically complex, frailer, more ill. As our resident population has changed, we’ve had to change the services we provide.”
Cloquet’s Sunnyside Health Care Center responded to falling demand for nursing home beds last fall by basically cutting its number of beds in half, from 88 to 44 beds. The change opened up an entire floor of the facility — which is attached to Community Memorial Hospital — creating a new space for the hospital’s occupational, speech and physical therapy departments.
While Sunnyside is exclusively a skilled nursing care facility, Carlton’s Inter-Faith describes itself as a “senior healthcare campus” offering a full continuum of care and services for seniors, including the 96-bed skilled nursing home known as Inter-Faith Care Center, the Carlton Place 18-unit assisted living facility and Pine View Apartments, which offers independent senior housing with 41 units. A walking tour of Inter-Faith reveals on-site physical and occupational therapy facilities for residents, jacuzzi tubs on each wing which are available to residents, stunning outdoor walkways, an enclosed garden space and even a beauty salon.
The most significant way Inter-Faith has responded to the changing demands in the industry has been by changing its focus more to rehabilitation. Long-term patients get more ongoing therapy so they are able to be as independent as possible in the nursing home. In addition, one of its long-term wings is now a short-term rehab facility, which serves people who are basically between the hospital and home, maybe recovering from a stroke, a broken hip, knee replacement or an injury.
“We have changed focus since I got here,” Anderson said, admitting that there have been struggles along the way as long-time staff and other community members resisted some of the changes. “The long-term residents aren’t out there anymore. They’re living somewhere less expensive and better for them. The focus today is about helping people live independently as long as possible and helping them maintain that independence.”
Nursing Director Joan Eastman said the changes over the last 15 years have been fairly dramatic.
“When a resident comes in, we start looking at the discharge process the day they arrive,” Eastman said. “How can we help you achieve your goals? How can we help you manage the pieces of your life? It’s a very client-centered focus and it means people come and people go.”
It’s different, she admits, but in a good way.
“It’s exciting for the industry and for the consumer,” Eastman said.
That change in focus has changed the way staff schedules work, it even changed the way activities are run.
Twenty-eight years ago, when Anderson started her career in elder care — she has been director at Inter-Faith since July 2011 — most nursing home patients went on more outings and participated in more complicated crafts like firing ceramics.
While Inter-Faith still offers a number of large group activities, such as worship services, singalongs and bingo, they’ve reduced some of the large-scale offerings in favor of smaller group sessions that take place at the nursing stations by their individual rooms. It’s easier for less-mobile patients to participate and smaller groups have a different kind of appeal and a higher staff-to-resident ratio.
Inter-Faith Activities Director Roxanne Hedlund said her staff manages the programming for whatever unit they serve.
“They take control of the activity programming for their residents,” Hedlund said, referring to the different units such as Cedar and Oak that make up the long-term care facility. “They know the residents, so they can engage them at their level.
Although they are invited, many of the patients in the short-term rehab unit don’t participate in activities, Hedlund said, noting that the focus there is more “work hard at rehab and get home as soon as possible.”
While there are still 96 long-term beds available, even those are not filled with long-term occupants, Anderson said. The turnover is much higher today, in part because patients arrive sicker and may not live as long, and because those who get better often go back home or to a different facility that better matches their needs for care.
Anderson cites the number of admissions over the past three years as proof of the fact that people no longer come into the nursing home and live in the same room for many years. In 2011, Inter-Faith had 51 admissions. In 2012, there were 68. In 2013, there were 171 admissions — 116 of those were short-term rehab patients on Medicare Part A or their own private insurance.
And as of the end of March, in 2014, there had been 50 admissions, which puts Inter-Faith on track to break the 200 mark this year if the numbers continue the same way.
National statistics show the same trend. Nursing home use (by Medicaid funded aged beneficiaries) peaked in 1994, at 1.4 million, according to a graph posted on the AARP website 10 months ago, which looked at number of users from 1975 to 2010. Since then, the numbers have been declining and have reached levels not seen since the 1970s, with the 2010 figure coming in at just over 1 million, despite the enormous growth among the oldest age groups most at risk of using nursing home services.
Diversifying services into short-term rehabilitation also makes sense financially for nursing homes. They already offer expensive nursing and therapy services. However, under state law, Minnesota nursing homes must charge every patient almost the same whether they’re private or public, roughly equivalent to the reimbursement rate paid for Medicaid patients.
According to a report commissioned by the American Health Care Association, the shortfall for Minnesota nursing homes in 2013 was $34.44 per nursing home patient, per day. That’s what they lose every day by providing care.
At Inter-Faith, Anderson estimated, those losses added up to $788,400 of revenue that didn’t come in.
Rates for short-term care, on the other hand, are higher and private rates are not tied to Medicare rates.
Having short-term rehab beds available also provides a needed service to the community, Anderson said, noting that Inter-Faith is a non-profit facility founded and run by a board of directors from area churches.
“Rather than our community folks leaving for Duluth or Minneapolis, they are able to stay here [and rehab], so their families don’t have to travel so far and they’re more comfortable,” she said, telling how a recently admitted patient arrived to find he knew six or seven of the 18 patients in the rehab unit. “It was like old-home week up there.”
Administrators say the changes are necessary, to ensure the long-term health of nursing home facilities and to better serve the changing needs of America’s growing elderly population.
Community Memorial Hospital Administrator/CEO Rick Breuer also said that while some feared the consolidation of the nursing home could mean a step toward closing it altogether, the new, more efficient configuration has actually resulted in making the future of Sunnyside “much more secure.”
It hasn’t been easy, but she believes the changes at Inter-Faith mean the facility will be around a long time to serve the community it was created to serve.
“We serve so many community needs,” Anderson said. “From hiring — we want to attract community members to come here and work — to providing care for loved ones, giving people a place to recuperate, even to providing large meeting spaces for community members.”